IOM supports removing scope of practice restrictions from Nurses

[Boatswain2PA]

Sometimes situations in life are not as they seem. When people give you things, sometimes it's wise to question it. Ask yourself, what do they have to gain? I know, I know I may sound cynical. Just ask yourself what do they have to gain? When they say they love PAs think about it. If I were an MD I would too. I can let them do all the "heavy lifting" while I build my practice and reap the benefits of business ownership. All the while they must remain subservient to me the MD. If I need extra work I can educate them on a part time basis at the local college. Maybe I could start my own school and make even more money on these guys. I could get away with this just by throwing them an occasional bone (I could give them credit for a year at a DO program or just tell them how smart they are. All the while knowing that the DO program would be full). Like they say, you are being bamboozled.

In the case of the relationship between PAs and MDs. MDs have one hand in your plate PAs, and one around your necks. You see yourselves, you see what they think of you from previous posts on this thread. I read this entire thread and it seems like PAs want to be more independent. Rns for the most part have remained silent on the issue.

Anyhow students, keep your heads up. This too shall pass. Any one of these career paths seem to be viable options. Just choose the one that works best for you.

Wow. You have now lost all credibility. Goodbye.

---

Members don't see this ad.

 

[PSYCHNP]

Take this up with the ANA. I did not make it up.

 

[deleted87716]

If you get a BSN as an undergrad, you can be a CRNA in as little as 3 years after college (1 year of required critical care experience, 2 years of NA school).

If you want to call yourself "doctor," add one year if you enroll in a combined MSNA-DNAP program.

 

[drift]

Anyhow one of the Med students stated this earlier:
After seeing what the typical DNP curriculum looks like, I don't plan to ever hire a DNP as well. Plus, if I'm going to be more qualified than a DNP as a 3rd year medical student, it's laughable (and rather frightening) that DNP's would ever try to gain the same practice rights as I will have as an attending.

Let's outline the educational pathway to becoming an advanced practice nurse. Let's say a nurse anesthetist:

1) Take prereqs to get into RN program
2) Be admitted into program many have long waitlists now
3) Go through the program with a high GPA so you could be admitted into anesthesia school
4) Take medical surgical, psych, peds, OB, and community health classes and do clinicals at the local teaching hospital
5) Pass the NCLEX exam
6) Apply to work in an ICU then be preceptored and trained (ACLS etc.) for several months prior to being allowed to practice as an ICU nurse
7) Work for a minimum of one year. Most schools prefer several prior to being admitted into school
8) Go through the anesthetist program for a minimum of 24 to I believe 36 months (Note: the program is full time, not online, and I would argue is much more rigorous than any PA program in the nation)
9) Sit the certification exam to become an anesthetist
10) Get a job at a teaching hospital where you will be preceptored some more
11) Apply to a DNP program where you will have to complete more clinical hours

Now Docs and PAs if this is the route you would like to take. You are more than welcome to attempt it. Good luck.

Honey, you can sugarcoat it all you want.

-RN + Grad school

-more than 75% of these "grad" school programs are online.

-Openly advertise applicants to be able to continue working full-time.

->60% of classes you take in this "grad" program are absolute fluff.

-Statistics for nurses, business management 101 for nurses, nursing theory, legal environment, health policy, healthcare economics & finance.. I got these from Vanderbilt's Doctor "NP" program.

-Vanderbilt's NP programs says:
Dates of Required On-Campus Atendance for DNP program
Block I August 30 - September 2, 2010
Block II January 10-14, 2011
Block III May 9-12, 2011

THAT'S 9 DAYS TOTAL ON-CAMPUS FOR A DNP WHO WANTS COMPLETE AUTONOMTY

-Almost all hover between 500-700 clinical hours.

-Then they graduate and call themselves specialists, when they hardly even have more knowledge then any "generalist" PA who would have more knowledge than them in not only the NPs "specialist" field, but every other NP "specialty".

-They want to be "full partners" with physicians.





Once again, PAs have it much better then NPs. More training. PAs make more money then NPs in almost every specialty (cept anesthesia/midwifery). Ability to work in every subspecialty imaginable. They are more respected by physicians...


...and oh yeah, they're not delusional!

 

[PSYCHNP]

To the PA I believe your ability to work in any subspecialty is a blessing and a curse. Let me explain, even MDs do not do this unless they have specialized training and have taken the necessary examinations for each field of endeavor. This gives prudence to the fact that you all must always be "under the watch" of a given MD who is a specialist in his field. Like I said in one of my earlier posts, where is the expertise if you are jumping from one speciaty to the next without adequate preparation? Wikipedia (2010) writes that the characteristics in the development of an expert have been found to include:

• "At a minimum usually 10 years of consistent practice, sometimes more for certain fields[citation needed]
• A characterization of this practice as "deliberate practice", which forces the practitioner to come up with new ways to encourage and enable themselves to reach new levels of performance[citation needed]"

As far as the money is concerned research shows that APNs have been found to be cost effective and proficient healthcare providers. Maybe that is why the IOM is supporting us. We welcome the challenge.

 

[drift]

2x post

 

[drift]

I found a link. I don't know if this is a typo or not. Anyhow, since we are all on the master's level we all know how to do our own research. All the best.

Wikipedia (2010) writes that the characteristics in the development of an expert have been found to include:

• "At a minimum usually 10 years of consistent practice, sometimes more for certain fields[citation needed]
• A characterization of this practice as "deliberate practice", which forces the practitioner to come up with new ways to encourage and enable themselves to reach new levels of performance[citation needed]"

As far as the money is concerned research shows that APNs have been found to be cost effective and proficient healthcare providers. Maybe that is why the IOM is supporting us. We welcome the challenge.

Your masters degree taught you how to use wikipedia to do "research"?


You hardly have 2-3 years of any practice, less part-time

 

[PSYCHNP]

I think the issue with many of you is that you do not consider nurses at the BSN level to be professionals. They are just as well as PTs, OTs, SLPs, etc.

Let's go back to the times of Florence Nightingale during the Crimean War. The MDs at the time were rendering medical interventions to the best of their ability. Yet, the soldiers were still dying in record numbers. What was missing in the equation? Care, care that was delivered by nurses. Mind you, these pioneers were women so you could imagine the barriers they faced.

It's 2010 now. Imagine one of your loved ones admitted in the hospital without competent nurses of all levels. Yes, the art and science of nursing (caring) is alive and well.

All the best folks.

 

[PSYCHNP]

More than half of your list is at the undergraduate level and teaches someone how to be a nurse. You're trying to tell us that following around a nurse all day doing the work of a nurse assistant in the one day per week clinical rotations is comparable to anything that has to do with medicine?

You quoted my comment that has to do with the DNP curriculum and only have this to say about it: "11) Apply a DNP program where you will have to complete more clinical hours?"

This is what I mean. Nurses are professionals too.

 

[deleted87716]

Practice nursing all you want. Quit trying to practice medicine.

FYI, nobody quotes Wikipedia. Is that what passes for peer review amongst nurses...?

 

[rmsgolfer]

I think the issue with many of you is that you do not consider nurses at the BSN level to be professionals. They are just as well as PTs, OTs, SLPs, etc.

Let's go back to the times of Florence Nightingale during the Crimean War. The MDs at the time were rendering medical interventions to the best of their ability. Yet, the soldiers were still dying in record numbers. What was missing in the equation? Care, care that was delivered by nurses. Mind you, these pioneers were women so you could imagine the barriers they faced.

It's 2010 now. Imagine one of your loved ones admitted in the hospital without competent nurses of all levels. Yes, the art and science of nursing (caring) is alive and well.

All the best folks.

Nurses are absolutely professionals, they are professionals in the field of nursing. Being a professional, you must also understand where your limitations are for the benefit of the patient. My mother is a nursing professor and tells her students consistently that it is the doctors job to diagnose and treat, it is the nurses job to help the patient while transitioning with those treatments. You are trained in a theory of nursing whose job is to accommodate the patient!!!

What on earth does a nurse providing wonderful care to a patient in the hospital have to do with the ability to diagnose and manage care. Nurses are extremely valuable and I have worked with dozens of fantastic nurses, but that has nothing to do with their ability to function as a doctor.

Does the fact that I can drive a car with a few people in it mean that I am trained to fly a plane full of passengers?

 

[prairiedog]

Well, I also put my money where my mouth is. I won't have my care given by a midlevel. When I need care, I make sure my provider is a physician. It's my right as a patient. The last time I was going to have elective surgery, I specifically requested an MDA. When I need to be seen for minor ailments, I see my physician, not the office PA.

Thus, if I follow your logic, when in the hospital as a patient you demand the BSN RN not the AD RN provides your care?

 

[rmsgolfer]

Thus, if I follow your logic, when in the hospital as a patient you demand the BSN RN not the AD RN provides your care?

Again, I don't think anyone here is inferring that they are hesitant to a nurse doing a nurses job. Apprehension comes from someone not trained as a full physician making the decisions as such.

 

[deleted87716]

As far as the money is concerned research shows that APNs have been found to be cost effective and proficient healthcare providers.

Not necessarily.

http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

Results. Resource utilization for patients assigned to a nurse practitioner was higher than that for patients assigned to a resident in 14 of 17 utilization measures (3 were statistically significant) and higher in 10 of 17 measures when compared with patients assigned to an attending physician (3 were statistically significant). None of the utilization measures for patients in the nurse practitioner group was significantly lower than those for either physician group.

Conclusions. In a primary care setting, nurse practitioners may utilize more health care resources than physicians.

We think it is important to emphasize that our study evaluated the practices of nurse practitioners who were supervised full-time by dedicated attending physicians; although the nurse practitioners were not required to get approval for testing or referrals, the presence of these physicians probably influenced their practice and brought it closer to physician norms. If indeed this was the case, then the differences that did exist may be magnified in an independent nurse practitioner practice or settings in which nurse practitioners collaborate with physicians who are busy seeing their own patients.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1872064/

Conclusion
Employing a nurse practitioner in primary care is likely to cost much the same as employing a salaried GP according to currently available data. There is considerable variability of qualifications and experience of nurse practitioners, which suggests that skill-mix decisions should depend on the full range of roles and responsibilities rather than cost.

 

[Charles_Carmichael]

As far as the money is concerned research shows that APNs have been found to be cost effective and proficient healthcare providers.

🙄

Sorry. Research doesn't show anything. Patient satisfaction does not equal proficient medical care...Some studies actually have found (as BD has pointed out) that nursing midlevels take a longer time and use more resources (ie. lab tests) to arrive at the same diagnosis as physicians. Not sure how that's "cost-effective."

Also, how are you guys going to be "cost-effective" when you're demanding equal reimbursements? Now that's arrogance! To have less than 10% of the training physicians receive and demand equal scope of practice and reimbursements as them.

 

[Charles_Carmichael]

Here's an old post of mine. As you can see, a 3rd year medical student has vastly superior training compared to NPs/DNPs. But you don't see them clamoring for a full scope of practice and equivalent reimbursements as full-fledged attendings though.

PSYCHNP, we have a pretty good idea of what NP/DNP training entails. And we know how much clinically useless stuff is in it too. Heck, an undergraduate biology degree has better basic science training than this does. Maybe we should let bio premeds who've volunteered in the hospital for a 100 hours practice independently?

"Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Now, let's look at the fluff courses that aren't really clinically useful: Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits, since you told me medicine is not evidence based), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).

Here are the clinically useful courses: Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, 37 credits are not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way, with a bunch of fluff courses (11 credits out of 43 required are fluff) and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:

• University of Arizona: http://www.nursing.arizona.edu/OSA/P...ndout_2008.pdf 31/74 credits are fluff.
• Loyola's MSN to DNP: http://www.luc.edu/nursing/dnp/curriculum.shtml (where are the basic science classes? They're all public health classes!!)
• MGH BSN to DNP: http://www.mghihp.edu/nursing/postpr...ulum.html?cw=1 (35/72 credits for Adult DNP are fluff while 46/83 credits for DNP in FM are fluff)

It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. I'll point out all the fluff courses here too. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Fluff courses at Baylor School of Medicine during M1/M2 years ONLY: Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Useful courses at Baylor School of Medicine during M1/M2 years ONLY: Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, 23 credits are fluff.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:

• UMich M1/M2: http://www.med.umich.edu/lrc/medcurr...gram/m1m2.html
• UMich M3/M4: http://www.med.umich.edu/lrc/medcurr...gram/m3m4.html
• Duke: http://medschool.duke.edu/modules/so...index.php?id=2

You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000"

I also want to point out that there are really no valid studies suggesting that NP/DNP outcomes are equivalent to those of physicians. NPs/DNPs always mention that studies show that patients are more "satisfied" with the care/attention they receive from NPs/DNPs than from physicians. However, patient satisfaction =/= quality medical care. I talk to patients all the time when I'm volunteering in the ED, etc, and several have told me they feel much better after talking to someone. That does not mean I should be allowed to practice independently.

 

[mig26x]

Anyhow one of the Med students stated this earlier:
After seeing what the typical DNP curriculum looks like, I don't plan to ever hire a DNP as well. Plus, if I'm going to be more qualified than a DNP as a 3rd year medical student, it's laughable (and rather frightening) that DNP's would ever try to gain the same practice rights as I will have as an attending.

Let's outline the educational pathway to becoming an advanced practice nurse. Let's say a nurse anesthetist:

1) Take prereqs to get into RN program
2) Be admitted into program many have long waitlists now
3) Go through the program with a high GPA so you could be admitted into anesthesia school
4) Take medical surgical, psych, peds, OB, and community health classes and do clinicals at the local teaching hospital
5) Pass the NCLEX exam
6) Apply to work in an ICU then be preceptored and trained (ACLS etc.) for several months prior to being allowed to practice as an ICU nurse
7) Work for a minimum of one year. Most schools prefer several prior to being admitted into school
8) Go through the anesthetist program for a minimum of 24 to I believe 36 months (Note: the program is full time, not online, and I would argue is much more rigorous than any PA program in the nation)
9) Sit the certification exam to become an anesthetist
10) Get a job at a teaching hospital where you will be preceptored some more
11) Apply to a DNP program where you will have to complete more clinical hours

Now Docs and PAs if this is the route you would like to take. You are more than welcome to attempt it. Good luck.

[/QUOTE]


are you trying to compare this to getting into medical school and then matching into residency? LOL. that's pretty funny. and then lets not forget about that thing we call board certification which is in another league of its own.

wow.

for medicine, I will mention only the tests
1- MCAT
2- USMLE 1
3- USMLE 2ck
4- USMLE 2cs
5- USMLE 3
6- after the end of each rotation in 3rd year of med school the shelf exam for obgyn, psych, med, surgery, peds and also during 2nd year
7- during residency in-training exam
8- board certification at the end of residency training

 

[drift]

are you trying to compare this to getting into medical school and then matching into residency? LOL. that's pretty funny. and then lets not forget about that thing we call board certification which is in another league of its own.

wow.

for medicine, I will mention only the tests
1- MCAT
2- USMLE 1
3- USMLE 2ck
4- USMLE 2cs
5- USMLE 3
6- after the end of each rotation in 3rd year of med school the shelf exam for obgyn, psych, med, surgery, peds and also during 2nd year
7- during residency in-training exam
8- board certification at the end of residency training

compare apples to apples

we established that the DNP curriculum is a joke compared to a Physician Assistant education...

Thus, why are we comparing a Nurse Practitioner to a Physician?!

🙄

 

[PSYCHNP]

Let's be honest here. The only real reason why NPs/DNPs can practice independently in some states is not because they receive solid training. It's because of how ridiculously powerful the nursing lobby is.

I mean, 3rd year medical students have far, far superior training (both basic science and clinical hours) compared to both NPs/DNPs. You don't see them clamoring for independent practice though.

And PAs definitely have better training than NPs do. How is all the fluff in the NP curriculum going to help you clinically? How are all those statistics classes, business management classes, nursing theory classes, etc useful in the clinic? If you want to be an independent provider, spend time learning phys, path, pharm, pathphys, etc. It almost feels like I have better basic science training from my MCB major than what these NP/DNP curricula provide. Don't take fluff courses and tell us you're equivalent/superior to physicians (which is what the nursing leadership has been stating).

I've honestly lost all respect for all advanced practice nurses over the past year; you can thank the media and their leadership for that. And I will never ever hire NPs/DNPs in the future. I'll stick with PAs who, not only have superior training, , but also don't pretend they're equal to physicians.

/end rant.

Why aren't you all persecuting the DPTs, OTDs, PsyDs, or PharmDs? I guess soon you all will jump on the PsyDs and DPTs when they move toward prescribing. This is all about money and you all know this.

Like I mentioned earlier, this is going to be my final post for a while. This goes out to all of the students out there. It was nice hearing from you all. You are a conscientious group. Some words to the wise that you may not find in any of the medical textbooks. Sometimes situations in life are not as they seem. When people give you things, sometimes it's wise to question it. Ask yourself, what do they have to gain? I know, I know I may sound cynical. Just ask yourself what do MDs have to gain when they say they love PAs? Think about it. If I were an MD I would too. I can let them do all the "grunt work" while I build my practice and reap the benefits of business ownership. All the while they must remain subservient to me, the MD. If I need extra work I can educate them on a part time basis at the local college. I could get my ego stroked all evening long and get a check at the same time, can't beat that. Yeah, I would have them calling me doctor for the entire evening. I would wear a bow tie and all. I would sell the PA students a dream.

Better yet, maybe I could start my own school and make even more money on these guys. I could sell them the microbiology study aids I made. Let's put out as many of this breed of "midlevel" as we can. I could get away with this just by throwing them an occasional bone (I could give them credit for a year at a DO program or just tell them how smart they are. While knowing in the back of my mind that the one DO program in town would be full). You PAs could see as many patients for me as you like, so long as you stay in your place. I would enjoy all of this without even having to compete with the top performers of my class, the surgeons.


This is cold and hard, but true. All the best students, study hard.

 

[fab4fan]

Honey, you can sugarcoat it all you want.

-RN + Grad school

-more than 75% of these "grad" school programs are online.

-Openly advertise applicants to be able to continue working full-time.

->60% of classes you take in this "grad" program are absolute fluff.

-Statistics for nurses, business management 101 for nurses, nursing theory, legal environment, health policy, healthcare economics & finance.. I got these from Vanderbilt's Doctor "NP" program.

-Vanderbilt's NP programs says:
Dates of Required On-Campus Atendance for DNP program
Block I August 30 - September 2, 2010
Block II January 10-14, 2011
Block III May 9-12, 2011

THAT'S 9 DAYS TOTAL ON-CAMPUS FOR A DNP WHO WANTS COMPLETE AUTONOMTY

-Almost all hover between 500-700 clinical hours.

-Then they graduate and call themselves specialists, when they hardly even have more knowledge then any "generalist" PA who would have more knowledge than them in not only the NPs "specialist" field, but every other NP "specialty".

-They want to be "full partners" with physicians.





Once again, PAs have it much better then NPs. More training. PAs make more money then NPs in almost every specialty (cept anesthesia/midwifery). Ability to work in every subspecialty imaginable. They are more respected by physicians...


...and oh yeah, they're not delusional!

You forgot "History of Jazz." I can snap my fingers to a syncopated rhythm with one hand while starting an IV with the other.

 

[PSYCHNP]

You forgot "History of Jazz." I can snap my fingers to a syncopated rhythm with one hand while starting an IV with the other.

That's a good one Fab!

 

[deleted87716]

That's a good one Fab!

I thought you were leaving? (Again.)

 

[fab4fan]

I thought you were leaving? (Again.)

Leaving this site? Never. You guys are stuck with me. I'm a dues paying member, sir. I told Winged Scapula I've been here so long I'm bucking for a special title since I'm the longest term nurse member here.

I learn so much just from reading the other forums. It's honestly helped my practice and knowledge base. In many ways it's a free education. I figure if I read a couple more years I could be like, you know, a doctor. 😉

ETA: Oh, that leaving comment wasn't directed at me, was it? A little slow on the uptake, eh?

 

[danielmd06]

This is cold and hard, but true.

Your comments aren't cold, hard, or true. Just angry, ill-conceived, and simply - wrong. But thanks for playing.

You clearly do not grasp the facts. I think it's because you don't want to. It's just too easy and too much fun to crusade against those arrogant, rich, doctors isn't it? Easier than studying to go to medical school at any rate.

"This is all about money and you all know this?" Get over it. This is about taking care of people. This is about demanding a certain level of professional education from potential providers before trusting them with the unsupervised care of patients. You want to practice under a physican's supervision? Learn to be a midlevel provider. You want to practice medicine unsupervised? Go to medical school. Who's stopping you? But I'm afraid you're going to have to sacrifice a lot more than 700 hours' worth of online courses out of your life.

To drive my earlier point home again...who truly suffers from allowing inadequately trained individuals to practice outside the scope of their training? Not physicians. Not the sons and daughters of the politicians in Washington. Trust me. It's the poor, underserved patients in the inner cities and rural country regions that will see the short end of the stick.

If you want more primary care physicians...train more primary care physicians. Don't presume that you can fix this problem with partially trained people.

 

[deleted6669]

Another comment on pa's in leadership roles:

Admiral Mike Millner, pa-c
Assistant surgeon general, US public health service
#2 honcho under only the surgeon general

 

[PSYCHNP]

Another comment on pa's in leadership roles:

Admiral Mike Millner, pa-c
Assistant surgeon general, US public health service
#2 honcho under only the surgeon general

Nice....Nice to see how astute you are Emed. You have gained my respect by your posts.

This site is all about the sharing and dissemination of information and expression of your thoughts, feelings, and concerns.

 

[PSYCHNP]

Your comments aren't cold, hard, or true. Just angry, ill-conceived, and simply - wrong. But thanks for playing.

You clearly do not grasp the facts. I think it's because you don't want to. It's just too easy and too much fun to crusade against those arrogant, rich, doctors isn't it? Easier than studying to go to medical school at any rate.

"This is all about money and you all know this?" Get over it. This is about taking care of people. This is about demanding a certain level of professional education from potential providers before trusting them with the unsupervised care of patients. You want to practice under a physican's supervision? Learn to be a midlevel provider. You want to practice medicine unsupervised? Go to medical school. Who's stopping you? But I'm afraid you're going to have to sacrifice a lot more than 700 hours' worth of online courses out of your life.

To drive my earlier point home again...who truly suffers from allowing inadequately trained individuals to practice outside the scope of their training? Not physicians. Not the sons and daughters of the politicians in Washington. Trust me. It's the poor, underserved patients in the inner cities and rural country regions that will see the short end of the stick.

If you want more primary care physicians...train more primary care physicians. Don't presume that you can fix this problem with partially trained people.

I see what you are saying, but historically Advanced Practice Nuses have been the ones who would serve such underserved populations. Just do the research on this. In many of these rural areas community health nurses would be the only providers some of these folks would see. This is one of the primary reasons NPs and nurse midwives are needed. MDs often times do not serve such populations.

 

[PSYCHNP]

Your comments aren't cold, hard, or true. Just angry, ill-conceived, and simply - wrong. But thanks for playing.

You clearly do not grasp the facts. I think it's because you don't want to. It's just too easy and too much fun to crusade against those arrogant, rich, doctors isn't it? Easier than studying to go to medical school at any rate.

"This is all about money and you all know this?" Get over it. This is about taking care of people. This is about demanding a certain level of professional education from potential providers before trusting them with the unsupervised care of patients. You want to practice under a physican's supervision? Learn to be a midlevel provider. You want to practice medicine unsupervised? Go to medical school. Who's stopping you? But I'm afraid you're going to have to sacrifice a lot more than 700 hours' worth of online courses out of your life.

To drive my earlier point home again...who truly suffers from allowing inadequately trained individuals to practice outside the scope of their training? Not physicians. Not the sons and daughters of the politicians in Washington. Trust me. It's the poor, underserved patients in the inner cities and rural country regions that will see the short end of the stick.

If you want more primary care physicians...train more primary care physicians. Don't presume that you can fix this problem with partially trained people.

This is going to be my final post before I take a hiatus. I hope all is well with the students out there. I am glad that you brought all of this up. Students what they teach you in class is often a far cry from reality. Most of the individuals who are underprivileged or disabled would commonly be insured by Medicaid and/or Medicare. In the case of visiting MDs they often would take Medicare if they came out at all. They would refuse to take Medicaid. I may need to elaborate more on reimbursement rates and look at the actual numbers in another post or thread in the future. I have heard MDs say the NP can do the visit. In the office setting MDs even go as far as to want the NP to see the Medicaid client and ask the NP to split the reimbursement with him. All the while the MD would strictly see the higher paying clients.

As far as specialists are concerned you cannot find a single orthopedic doctor in our area who would take Medicaid. I am noticing that gynecologists and opthalmologists are following this same trend. At times the reinbursement rates under such programs are so low that it would not be practical to provide the service. Provider shortage issues are magnified in rural and inner city areas.

You seem to show genuine concern for these populations, but historically Advanced Practice Nuses have been the ones who would serve them. Just do the research on this. In many of these rural areas community health nurses would be the only providers some of these folks would see. This is one of the primary reasons NPs and nurse midwives are needed.

In my personal experience NPs would go to the ALF or halfway house and accept the Medicaid clients. MDs would not. Like one of the previous posts stated, perhaps they are just "too busy".

 

[deleted87716]

I see what you are saying, but historically Advanced Practice Nuses have been the ones who would serve such underserved populations. Just do the research on this. In many of these rural areas community health nurses would be the only providers some of these folks would see. This is one of the primary reasons NPs and nurse midwives are needed. MDs often times do not serve such populations.

Nope. As a group, nurses go to the same places doctors go. Someone hanging out a shingle in BFE makes for a good news story, but in reality, there are just as few rural NPs out there as there are rural docs. There is research to back this up...I've seen the dots-on-a-map studies myself showing where doctors and NPs locate their practices. The distributions overlap.

As long as primary care remains unattractive to doctors, it will remain equally unattractive to anyone else.

 

[danielmd06]

I see what you are saying, but historically Advanced Practice Nuses have been the ones who would serve such underserved populations. Just do the research on this. In many of these rural areas community health nurses would be the only providers some of these folks would see. This is one of the primary reasons NPs and nurse midwives are needed. MDs often times do not serve such populations.

Of course it's terrible that so many people have no care. The first problem is there aren't enough overall primary care physicians to even try and take care of these people, regardless of their insurance or lack thereof. So the nursing lobby keeps advocating to allow undertrained advanced nurses to do the job. They keep saying "nurses are better than nothing." No one thinks to say "lets train more primary care physicians!" Which route do you really think is a better solution (resulting in better health care) for these patients?

Blue Dog is speaking truth. Read his posts carefully. The second problem is that there are some strong motivating factors for physicians to NOT practice primary care. If people are truly, truly interested in correcting this problem with access to primary care (and it's a very serious problem that is well worth fixing) then we need to talk openly about the current flaws in the system and how to address them so that quality of care is not sacrificed and access to care is improved.

 

[Boatswain2PA]

This is going to be my final post before I take a hiatus.

You are practicing a very effective political tool here - if you repeat a falsehood often enough people will begin to believe it. You have repeatedly said "this will be my final post", but it seems to never actually be your final post. Same thing with the DNP = Doctor scheme. The nursing mafias try to get that into the media as often as they can because if they repeat it enough, people will start to believe it.

Most of the individuals who are underprivileged or disabled would commonly be insured by Medicaid and/or Medicare. In the case of visiting MDs they often would take Medicare if they came out at all. They would refuse to take Medicaid......You seem to show genuine concern for these populations, but historically Advanced Practice Nuses have been the ones who would serve them.

You just proved Daniel's point. With independent practice, NPs are allowing our healthcare system to justify providing a lower standard of care to our poor. As a holder of a graduate level degree (especially a degree which focused on such esoteric classes as Advanced Patient Discussion practices, Advanced Patient Conversation Ideologies, and Advanced Unit Scheduling) you should be able to identify the importance of these two interconnected ideas.

Just do the research on this. In many of these rural areas community health nurses would be the only providers some of these folks would see. This is one of the primary reasons NPs and nurse midwives are needed.

Ahhhh....back to the original tactic of repeating the incorrect party line until people start believing it. However it's not true. Despite the push from many PA/NP schools to send their students out into rural areas, more and more midlevels are staying right in the urban centers playing right alongside REAL doctors. This is most easily seen in the PA workforce since the AAPA/PAEA keeps great metrics on the PA students/workforce, but it is also happening in the NP field. I'd bet money that the NPs will do so even more as they complete their conversion to doctorate.

 

[Boatswain2PA]

Of course it's terrible that so many people have no care. The first problem is there aren't enough overall primary care physicians to even try and take care of these people, regardless of their insurance or lack thereof. So the nursing lobby keeps advocating to allow undertrained advanced nurses to do the job. They keep saying "nurses are better than nothing." No one thinks to say "lets train more primary care physicians!" Which route do you really think is a better solution (resulting in better health care) for these patients?

Daniel - how would you feel about remotely supervising midlevels? I can see a future where experienced physicians see fewer patients, but spend more time supervising multiple midlevels. Care to share your thoughts?

 

[Coastie]

Rofl....crna school is nowhere near as intense or hard as PA school.

Why can't the psychnp diagnose her own psychosis?

The way you all describe DNP education is a half truth and you all know this.

Let's outline the educational pathway to becoming an advanced practice nurse. Let's say a nurse anesthetist:

1) Take prereqs to get into RN program
2) Be admitted into program many have long waitlists now
3) Go through the program with a high GPA so you could be admitted into anesthesia school
4) Take medical surgical, psych, peds, OB, and community health classes and do clinicals at the local teaching hospital
5) Pass the NCLEX exam
6) Apply to work in an ICU then be preceptored and trained (ACLS etc.) for several months prior to being allowed to practice as an ICU nurse
7) Work for a minimum of one year. Most schools prefer several prior to being admitted into school
8) Go through the anesthetist program for a minimum of 24 to I believe 36 months (Note: the program is full time, not online, and I would argue is much more rigorous than any PA program in the nation)
9) Sit the certification exam to become an anesthetist
10) Get a job at a teaching hospital where you will be preceptored some more
11) Apply to a DNP program where you will have to complete more clinical hours

Now Docs and PAs if this is the route you would like to take. You are more than welcome to attempt it. Good luck.

 

[altap]

There should be no reason for residency programs in primary care not to fill up all of their slots. That's why I've been perorating that all residency programs in primary care offer observerships (paid or not) to foreign born FMGs. By doing this, residency programs would be able to see the capabilities (gen. medical knowledge, work ethics, rapport with others and clinical acumen) of these foreign born FMGs. It would be interesting to see how US med grads or US born FMGs, who more often than not have better scores in Step 1, perform against foreign born FMGs who passed both Steps 1 and 2 CK and CS and who practiced as attendings, residents or GPs in primary care in their country of origin.

 

[maceo]

Why aren't you all persecuting the DPTs, OTDs, PsyDs, or PharmDs?

because the professionals you mentioned actually have an education. Do you know the science that the pharmDs must endure? or the physical therapists? Its not fluff. Its actually hardcore science before they even begin studying their field. Nurses have no real backround in science, no real cliniical exposure tot he medical field no eveidence of academic sacrifice No evidence of excelling in academics and you want independence.// ask yourself this/... would you wan someone like you taking care of you in the hospital? seriously!!

 

[PSYCHNP]

Daniel - how would you feel about remotely supervising midlevels? I can see a future where experienced physicians see fewer patients, but spend more time supervising multiple midlevels. Care to share your thoughts?

Folks I know I said that I was going on a hiatus. I am in the final stages of doing so. I had a dream last night that I must share. I had a revelation. What I experienced was a premonition of sorts. It even gave me the chills.
I foresaw PAs being used “to their full potential” much the same as nurses will be. I foresee this taking place sooner than many anticipate. With PharmDs, DNPs, and DPTs now welcoming higher education PAs will soon follow.
Like in Exodus 10 when Moses and the Egyptians left Pharoah.
Like when the American colonies left England in 1776.
MDs you are in for a rude awakening. Only after your PAs leave you, like a spouse in an abusive relationship, will you accept the paradigm shift taking place in healthcare. You see, the foundation of an empire cannot be one of deception, disrespect, exploitation, and lies.
“You see once you realize the levels and the rules of this game we call life, it is no longer a mystery, it is no longer a game to be played.” PSYCHNP, 2010

 

[PSYCHNP]

I don't see pa's ever becoming independent. I think what will happen over time is more pa's will choose to do residencies to meet credentialing requirements of various healthcare systems and hospitals. this will lead to a decrease in the ability of pa's to switch specialties over time. anyone will be able to do primary care right out of school but to do anything else will require a residency or prior experience.
states will continue to loosen supervisory requirements(some states already say "sponsorship" ) of pa's much like the np's who have "collaborating physicians" in those states where they don't practice independently but I don't ever see pa's working independently of physicians. those who want independent practice will go back to med school either by the traditional route or through a 3 yr bridge program(now that there is 1 I forsee many more soon).

Folks I know I said that I was going on a hiatus. I am in the final stages of doing so. I had a dream last night. I had a revelation. What I experienced was a premonition of sorts. It even gave me the chills.
I foresaw PAs being used “to their full potential” much the same as nurses will be. I foresee this taking place sooner than many anticipate. With PharmDs, DNPs, and DPTs now welcoming higher education PAs will soon follow.
Like in Exodus 10 when Moses and the Egyptians left Pharoah.
Like when the American colonies left England in 1776.
MDs you are in for a rude awakening. Only after your PAs leave you, like a spouse in an abusive relationship, will you accept the paradigm shift taking place in healthcare. You see, the foundation of an empire cannot be one of deception, disrespect, exploitation, and lies.
“You see once you realize the levels and the rules of this game we call life, it is no longer a mystery, it is no longer a game to be played.” PSYCHNP, 2010

 

[PSYCHNP]

Like I mentioned earlier, this is going to be my final post for a while. This goes out to all of the students out there. It was nice hearing from you all. You are a conscientious group. Some words to the wise that you may not find in any of the medical textbooks. Sometimes situations in life are not as they seem. When people give you things, sometimes it's wise to question it. Ask yourself, what do they have to gain? I know, I know I may sound cynical. Just ask yourself what do MDs have to gain when they say they love PAs? Think about it. If I were an MD I would too. I can let them do all the "grunt work" while I build my practice and reap the benefits of business ownership. All the while they must remain subservient to me, the MD. If I need extra work I can educate them on a part time basis at the local college. I could get my ego stroked all evening long and get a check at the same time, can't beat that. Yeah, I would have them calling me doctor for the entire evening. I would wear a bow tie and all. I would sell the PA students a dream.

Better yet, maybe I could start my own school and make even more money on these guys. I could sell them the microbiology study aids I made. Let's put out as many of this breed of "midlevel" as we can. I could get away with this just by throwing them an occasional bone (I could give them credit for a year at a DO program or just tell them how smart they are. While knowing in the back of my mind that the one DO program in town would be full). You PAs could see as many patients for me as you like, so long as you stay in your place. I would enjoy all of this without even having to compete with the top performers of my class, the surgeons.


This is cold and hard, but true. All the best students, study hard.

Keep your eyes on the prize students. I am officially now on a hiatus.

 

[Coastie]

Ahahahhahahahahhaha...I actually laughed out loud when I read this.

Folks I know I said that I was going on a hiatus. I am in the final stages of doing so. I had a dream last night. I had a revelation. What I experienced was a premonition of sorts. It even gave me the chills.
I foresaw PAs being used “to their full potential” much the same as nurses will be. I foresee this taking place sooner than many anticipate. With PharmDs, DNPs, and DPTs now welcoming higher education PAs will soon follow.
Like in Exodus 10 when Moses and the Egyptians left Pharoah.
Like when the American colonies left England in 1776.
MDs you are in for a rude awakening. Only after your PAs leave you, like a spouse in an abusive relationship, will you accept the paradigm shift taking place in healthcare. You see, the foundation of an empire cannot be one of deception, disrespect, exploitation, and lies.
“You see once you realize the levels and the rules of this game we call life, it is no longer a mystery, it is no longer a game to be played.” PSYCHNP, 2010

 

[Boatswain2PA]

Psych - you really should get some help with that stutter. I recommend you go see a Doctor or a PA.

 

[Dwindlin]

Best. Post. Ever.

Folks I know I said that I was going on a hiatus. I am in the final stages of doing so. I had a dream last night that I must share. I had a revelation. What I experienced was a premonition of sorts. It even gave me the chills.
I foresaw PAs being used “to their full potential” much the same as nurses will be. I foresee this taking place sooner than many anticipate. With PharmDs, DNPs, and DPTs now welcoming higher education PAs will soon follow.
Like in Exodus 10 when Moses and the Egyptians left Pharoah.
Like when the American colonies left England in 1776.
MDs you are in for a rude awakening. Only after your PAs leave you, like a spouse in an abusive relationship, will you accept the paradigm shift taking place in healthcare. You see, the foundation of an empire cannot be one of deception, disrespect, exploitation, and lies.
“You see once you realize the levels and the rules of this game we call life, it is no longer a mystery, it is no longer a game to be played.” PSYCHNP, 2010

 

[deleted87716]

You are now officially trolling. 🙄

 

[danielmd06]

Folks I know I said that I was going on a hiatus. I am in the final stages of doing so.

You're obviously not here for rational or intelligent discussion. So as I said before...good riddance.

 

[danielmd06]

Daniel - how would you feel about remotely supervising midlevels? I can see a future where experienced physicians see fewer patients, but spend more time supervising multiple midlevels. Care to share your thoughts?

I would truly worry about doing medicine "remotely." It doesn't sound appropriate for quality of care to the patients.

I do have full confidence in PA's, however.

 

[fab4fan]

I think a dab of haloperidol is in order here.

But seriously, my Spidey-sense tells me that this poster is actually another "nurse" poster who went by a different screen name. I'm not willing at this point to name names, but the writing style is similarly unhinged.

I'll be watching.

 

[deleted6669]

duplicate post

 

[deleted6669]

Daniel - how would you feel about remotely supervising midlevels? I can see a future where experienced physicians see fewer patients, but spend more time supervising multiple midlevels. Care to share your thoughts?

that's not the future, that's today...as long as there is a mechanism for consult and review I think the system works well. my primary job is set up this way and I know many other pa's who work in rural settings solo who do this as well. the key is not allowing inexperienced new grads to work alone. 5 yrs of closely monitored postgrad clinical experience or a pa residency is a good foundation for remote practice. this is not "independent practice" as there is always a mechanism for stat consult and oversight. where I work now I have access to physician referals/consults/rads overreads, etc
there should be a system in place that requires consults or transfers of certain types of pts.
a good pa has a reasonable understanding of "what they don't know" and consults accordingly.

 

[danielmd06]

that's not the future, that's today....

Interesting. Do you do EM?

 

[deleted6669]

Interesting. Do you do EM?

yup, for the last 23 yrs(see my signature).
I work level 1 and 2 trauma ctrs as well as rural/critical access and underserved/solo positions.
at my solo night gig we staff pa's 24/7 and docs on day shift only. the day doc reviews all charts from the past 24 hrs. newer grads work day shift with a doc there while those of us with > 10 yrs experience tend to migrate to the night shifts. we always have a doc available for consults and have transfer agreements with a regional facility for trauma/cva/acs/etc transfers. a lot of our sicker pts are stabilize and ship( I saw 18 on night shift last night and transfered 7).

 

[princekc]

Psych - you really should get some help with that stutter. I recommend you go see a Doctor or a PA.

...completely agreed! She ended her quote as "PSYCHNP 2010" My question is she really an NP or a Psych NP to be comes 12/2010 or she's just psycho? I honestly think y'all should stop feeding her with responses.